Transcatheter Mitral Valve Replacement in Native Mitral Valve Disease With Severe Mitral Annular Calcification: Results From the First Multicenter Global Registry

The authors describe their findings in a multicenter retrospective review of clinical outcomes in 64 patients with severe mitral annular calcification considered poor candidates for traditional surgical mitral valve replacement, undergoing transcatheter mitral valve implantation with a balloon expandable prosthesis. There were procedural complications in 13 patients (20%): LVOT obstruction in 6, embolization in 4 and perforation in 3 cases. Periprocedural death occurred in 19 patients (29.7%). Most survivors reported significant improvement of symptoms. At 30 days, 21 of the 25 patients (84%) with 30-day clinical follow-up data were in NYHA functional class I or II.
The authors concluded that transcatheter mitral valve implantation with balloon-expandable valves designed for aortic position is feasible in this extremely high-risk patient population. Technical success was achieved in most patients. Although there were important complications and a high 30-day mortality, these results are encouraging considering this represents the first human experience with a transcatheter heart valve not designed for the mitral position and used in an extremely high-risk patient population.